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Dr K K Aggarwal

The era of Ram andKrishnarepresents two different perceptions of life. While Rama taught us the message of truthfulness,Krishnatold when not to speak the truth and when speaking a lie is justifiable. Medical profession today cannot survive on the principles of Rama. According to principles ofKrishnaa truth which if spoken may cause harm to someone and if not spoken does not end in any harm may not be spoken. Similarly, a lie which without harming the community may help a particular person or situation may be spoken. In medical profession doctors come across situations on a daily basis where speaking the truth may be harmful to the patient. Quite often false hopes are given and patients of terminal cancer are not told about their exact nature of illness and the prognosis. There is no way a doctor is going to tell the patient that you are going to die in the next 24 hours even if it is medically true. Dharma, artha, kama and moksha are the four basic purposes of life for which we are born. The basic purpose of life is to fulfil our desires in such a way that we end up in inner happiness. Fulfillment of desires should be done by following the principles of righteous or ethical earning. Taking more money from the rich and helping the poor is what the medical professionals are taught from day in and day out. This principle will fall more onKrishna’s principle than on Rama’s. most charges in the hospital settings are different depending upon the categories chosen by the patient. A single room patient invariably has to pay more than a patient admitted in the concessional three-bed room or general ward. Even the charges of the treatment, operation theatre, investigations and consultations may be different depending upon the categories. Placebo therapy is a well established therapy in medical science which means treating the patient without giving the actual drug to a patient.this information that the durg does not contain any ingredient is withhold from the patient in this type of therapy. As per the literature 35% of the illnesses and symptoms may resolve using a placebo and is based on the principle that the very feeling that a medicine is being given stimulates the inner body pharmacy and produces healing substances and chemicals.

Nacebo effect on the other hand means that if the patient is told that your illness is not going to cure even if medicines are given they may not act as the patient’s body produces negative chemicals which neutralizes the effect of even effective medicines.

Indian doctors were known for their social medicine which involve proper assessing of patients’ and their families’ financial status before deciding the treatment. There is no point giving options to a family to spend 10-15 lakhs of rupees for getting an ICD device implanted in the heart, which may increase life span only by one or two years or only give good quality of life for a few years. But to a family who cannot afford this amount of money and may have to sell their house or spend all the money saved for the marriage of their daughters.

But in today’s Consumer Act era not informing the family may even amount to negligence.

How To Prevent Getting Lifestyle Diseases Including Heart Attack

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Wild animals do not get heart attack, blood pressure, diabetes or stroke. These are all lifestyle disorders. But they can occur in a lion caged in a zoo, a rabbit in a laboratory or a pet dog in the house.

The biggest challenge, therefore, in cardiology internationally is – how to prevent getting lifestyle diseases including heart attack.

Most lifestyle disorders are linked to abdominal obesity which is the latest epidemic in the society in the west and is also becoming an epidemic in urban India which is now gradually shifting to middle class. It is linked to eating white sugar, white rice, white maida and not exercising.

Traditionally, Indian sages knew that Indians are prone to getting abdominal obesity, therefore, they promoted observing fast at least 80 days in a year which involves one fast every week, one extra fast on Ekadashi and two Navratras of nine days each at the onset of summer and winter. Traditionally, the Indian fast includes not eating cereals on the fast day. Avoiding cereals 80 days in a year does not allow a person to develop metabolic syndrome and insulin resistance which is responsible for inflammation of arteries and subsequent lifestyle disorders including heart attack and paralysis.

The other challenges at an international level in cardiology involve safer alternatives for surgery and angioplasty. Today, most angioplasties with stenting and bypass surgeries last 6-10 years. We want such procedures to last lifelong, obviously with control of risk factors. Stents are needed which can be resorbed completely.

A  large number of patients die because cardiac transplant facilities are not available in many countries, especially the Asian countries. Every country should have all transplants friendly laws so that any patient who dies in an accident with death of brain but living heart ends up as a heart living brain dead donor. In India, thousands of patients die every year for want of a heart donor.

Diastolic dysfunction, heart failure and atrial fibrillation are other new epidemics of the society.  In diastolic dysfunction, the heart does not relax properly and leads to breathlessness on exertion. It is again linked to obesity. If not treated in time, it ends up in the enlargement of the left smaller chamber of the heart called left atrium. This over a period of time gets enlarged and ends up into new epidemic of the society called Atrial Fibrillation where the heart beats are irregularly irregular. This is the commonest cause of paralysis in elderly age group.

Most of the lifestyle disorders are also linked to eating high salt diet and/or a diet high in transfats. Every country must come out with its policy and guidelines in which they must restrain various restaurants and hotels from using trans fats in their food and limiting the content of salt in their dishes.

They are also challenges for cardiologists. A cardiologist must practice what he preaches.  A patient will not listen to the cardiologist if he ( the cardiologist) is overweight and has abdominal obesity, drinks excessive alcohol or smokes.

 Cardiologists internationally also face legal threat. Most of the law suits in the west are on cardiologists, especially linked to the need of putting a stent or doing bypass surgery. Clear cut guidelines should be laid down and an impunity should be given to doctors, if they follow those guidelines.

It is a duty of the cardiological association  of every country to come out with transparent and standard guidelines in the treatment of heart diseases and when not to put devices in a patient.

Due to lucrative packages, a large number of cardiologists are shifting towards interventional cardiology. Very few people, a time will come, will remain in clinical, preventive or diagnostic cardiology. It will be sad scenario to watch, if it happens.

Young doctors and medical students should devote their life to combat these challenges. They must learn the principles of vedic philosophy, especially ethical earning.

They must follow the principles of counseling as taught by Lord Krishna to Arjuna. Krishna took 18 counseling sessions. In the first, he only listened, in the second he counseled in great detail, from 3 to 17, he gave reasoning at every stage and in the last session, he revised.

The budding doctors must remember that the word ‘Dr.’ as a prefix is given to them as an honour which differentiates them from the society. These prefixes or suffixes are not even available even to Prime Minister or President of India. They must maintain nobility of the medical profession.

In Islam, one of the five pillars mentioned is compulsory charity. The budding doctors should decide at this stage that throughout their life they will involve in doing 10% of charity on a daily basis.

1.     Relaxation techniques share two components: the repetitive focus (on a word, sound, prayer, phrase, body sensation, or muscular activity) and adoption of a passive attitude (towards intrusive thoughts.)

2.     They induce relaxation response characterized by decreased arousal and diminished sympathetic activity (decreased heart rate and lower blood pressure).

3.     There occurs increased EEG slow wave activity.

4.     Relaxation techniques may be subdivided into two methods, deep and brief, or by the specific strategy used to induce the relaxed state, including progressive muscle relaxation, autogenic training, and breath training.

5.      Adverse reactions are intrusive thoughts, fear of losing control, upsetting sensory experiences, muscle cramps, sexual arousal, and psychotic symptoms [1].

6.      Adverse reactions are relaxation-induced anxiety or relaxation-induced panic.

7.     Relaxation-induced anxiety is a gradual increase in behavioral, physiologic, and psychological anxiety, whereas relaxation-induced panic is severe anxiety of rapid onset [2].

8.     Patients with a history of generalized anxiety disorder or panic disorder and those with a history of hyperventilation are more likely to experience these adverse effects.

9.      Patients should also be introduced to deep breathing techniques that often accompany relaxation in a gradual manner and not more than couple of minutes at a time.

10.   Relaxation techniques can recue pain in cancer [3].

References

1.     Jacobsen R, Edinger JD. Side effects of relaxation treatment. Am J Psychiatry 1982; 139:952.

2.     Adler CM, Craske MG, Barlow DH. Relaxation-induced panic [RIP]. When resting isn’t peaceful. Integr Psychiatry 1987; 5:94.

3.      JAMA 1996; 276:313.

CDC: New Recommendations for Treating Gonorrhea

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  • The treatment recommendations for gonorrhea have changed substantially during the past 5 years.
  • Because of a high rate of antimicrobial resistance, fluoroquinolones are no longer recommended to treat gonorrhea.
  • To treat a potential coinfection with chlamydia, the treatment regimen for gonorrhea should include either a single dose of azithromycin or 1 week of doxycycline, even if testing for Chlamydia trachomatis is negative at the time of treatment.
  • The mainstays of treatment for gonorrhea have been intramuscular ceftriaxone or oral cefixime.
  • However, there is concern regarding the susceptibility of Neisseria gonorrhoeae to cefixime.
  • The CDC now recommends that gonorrhea be treated with ceftriaxone 250 mg intramuscularly in a single dose, not with cefixime. Ceftriaxone should be combined with azithromycin 1 g once only or doxycycline 100 mg twice daily for 7 days.

 

Massage Therapy

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1.     Is used as a form of medical therapy since ancient times.

2.     Ayurveda text written 5000 years old also talks about it

3.     The Yellow Emperor’s Classic of Internal Medicine, written more than 2500 years ago and believed to be the first book on Chinese medicine, includes information on Tuina, an ancient form of massage, and acupressure (applied finger pressure to points that are putatively sensitized by organ impairment) [1].

4.     Massage is systematic manipulation of the soft tissues of the body to enhance health and healing [2].

5.     It includes a group of manual techniques that include applying fixed or movable pressure.

6.     The primary characteristics are the application of touch and movement.

7.      Studies in patients with limited or advanced cancer suggest at least temporary benefit for pain, other symptoms and mood [3,7]

8.     It is well proven in pain management

9.     Massage also produces VIP hormone which dilates the arteries and increases the flow

References

1.     Monte T. World medicine: the East and West guide to healing your body, Putnam, New York 1993.

2.     Goats GC, Keir KA. Connective tissue massage. Br J Sports Med 1991; 25:131.

3.     Ferrell-Torry AT, Glick OJ. The use of therapeutic massage as a nursing intervention to modify anxiety and the perception of cancer pain. Cancer Nurs 1993; 16:93.

4.     Weinrich SP, Weinrich MC. The effect of massage on pain in cancer patients. Appl Nurs Res 1990; 3:140.

5.     Cassileth BR, Vickers AJ. Massage therapy for symptom control: outcome study at a major cancer center. J Pain Symptom Manage 2004; 28:244.

6.     Listing M, Reisshauer A, Krohn M, et al. Massage therapy reduces physical discomfort and improves mood disturbances in women with breast cancer. Psychooncology 2009; 18:1290.

7.     Kutner JS, Smith MC, Corbin L, et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial. Ann Intern Med 2008; 149:369.

 

Jalneti Linked to Rare Brain Disease

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A rare brain disease previously seen mainly in swimmers is now turning up in some people who do Jalneti.

Jonathan S. Yoder, MSW, MPH, an epidemiologist from the NationalCenterfor Emerging and Zoonotic Infectious Diseases at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, and colleagues studied 2 cases of primary amebic meningoencephalitis (PAM) that occurred in patients who irrigated their sinuses with neti pots and contaminated tap water. The authors report their findings in an article published online August 23 in Clinical Infectious Diseases. [Medscape]

PAM is caused by Naegleria fowleri, a free-living ameba that feeds on bacteria and is often found in natural bodies of warm freshwater. It thrives in warm water (up to 45°C) and most often infects swimmers by traveling up the nose, along the olfactory nerve, through the cribriform plate, and to the brain, killing its victim within about 5 days.

NIH and FDA in USA  a decade ago declared in a consensus statement that acupuncture is not an experimental therapy but a sound medical technique comparable in effectiveness to common conventional medical treatments for certain clinical conditions, such as nausea and pain [1].

Acupuncture is a safe and effective therapy to help manage cancer pain and other cancer treatment-related symptoms [2,5].

A systematic review examined 26 articles published between 1999 – 2008 on the application of acupoint stimulation vasomotor syndrome, chemotherapy-induced nausea and vomiting, lymphedema, postoperative pain, aromatase inhibitor-related joint pain, and leucopenia in breast cancer [6]. Modalities included traditional acupuncture, acupressure, electroacupuncture, and the use of a magnetic device on acupuncture points. Overall 88% trials reported positive outcomes on at least one of the conditions examined.

Acupuncture or acupressure can be recommended as an adjunct therapy for nausea and possibly for pain [7].

 References

1.      J Altern Complement Med 2008; 14:871.

2.     Hematol Oncol Clin North Am 2008; 22:631.

3.      J Tradit Chin Med 1986; 6:23.

4.     J Clin Oncol 2003; 21:4120.

5.     J Tradit Chin Med 1998; 18:31.

6.     Breast Cancer Res Treat 2009; 118:255.

7.     Am J Hosp Palliat Care 2008; 25:298.Never feel bad when people remember you only in their bad times. It is because they think you as a candle in the darkness of their life

Debunking Diabetes Myths

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If you’ve just been diagnosed with diabetes, it may be difficult to separate fact from fiction. Some popular myths about diabetes.

• Diabetes is not contagious and one cannot get diabetes from someone else.
• Diabetics can eat desserts, but with caution. While eating too many sugary foods is a bad idea, one can have an occasional dessert, especially if one exercises and otherwise eats healthy.
• Eating too much sugar cannot “cause” diabetes. The disease stems from genetic and lifestyle factors. But consuming too much white sugar can cause insulin resistance and future diabetes. The healthy sugar is brown sugar or jaggery.
• Diabetics aren’t more susceptible to colds and other illnesses but may have more complications of flu.
•  Taking insulin doesn’t cause hardening of the arteries or high blood pressure.
•  Fruit, while healthy, can’t be consumed in huge amounts, since it contains carbohydrates

Workshop for Teachers on Proper Hygiene in schools

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While conducting a workshop on health and hygiene organized by Heart Care Foundation of India and DAV School, Kailash Hills, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India, said that school education must focus on health and hygiene. This will take care of the burden of communicable diseases and provide healthy and correct lifestyle and prevent most non-communicable diseases.

He said that to start with, children should clean their teeth properly as chronic poor oral health and tooth loss is associated with modest increases in future heart blockages and paralysis. This effect persists even after adjustment for known cardiovascular risk factors.

Keeping the environment clean can prevent a large number of communicable diseases. Environment hygiene includes air hygiene, water hygiene and food hygiene. Most food-borne diseases are direct food or water-borne illnesses. Typhoid fever is caused by a bacterium, Salmonella typhi, and is transmitted through the ingestion of food or drink contaminated by the feces or urine of infected people. Houseflies or other flying insects feeding on feces may occasionally transfer the bacteria through poor hygiene habits and public sanitation conditions. Though the cases occur round the year, typhoid occurs more often during summer and rainy seasons.

Do not eat fruits and vegetables that are cut and sold open as they can cause diseases such as typhoid, diarrhea, cholera and jaundice. Cut open fruits and vegetables, especially watermelon, sold on the streets and sugarcane juice attract flies and other infective organisms. Any food stored at room temperature for over two hours gets spoiled and may grow organisms. Cut open fruits on the road often remain in this state for hours together. In summer, precautions should also be taken while eating cut salad and uncovered food in the tiffin. The best fruits to eat in such situations are bananas and oranges.

Healthcare-associated infections are also becoming common. Therefore, one should avoid visiting a hospital for a formality.

A heart attack may occur at the age of 40 but the process of heart artery blockages starts in school age and early college life. To prevent the rising burden of obesity, diabetes, heart diseases, prevention must begin in school age.

Teachers from over 50 schools participated in the event. The participants included teachers, vice-principals and principals of various schools. Speaking on the occasion, Ms Era Khanna, Principal of DAV,KailashHillsSchool said that the teachers who are trained in this workshop will work like trainers for other teacher and school children. She said that every school must have a teacher who is trained to educate children on health and hygiene.

The subjects covered in the workshop were food hygiene, hand hygiene, water hygiene, respiratory hygiene and sexual parts hygiene.

1.  Music therapy can ameliorate physical and emotional distress.

2.  It can improve distress caused by pain, decrease muscle tension and promote relaxation, decrease anxiety, improve chemotherapy-related nausea and emesis, and improve overall mood [1,2].

3.  It can help manage postoperative nausea and vomiting [3].

4.  It reduces pain intensity levels and opioid requirements [4,5].

5.  Music has significant effect on anxiety, perception of hospitalization or procedure, relaxation and stress levels in brain tumor patients undergoing surgery [6,7].

6.  Music therapy in treatment areas and hospital rooms may help to improve mood and decrease anxiety in cancer patients.

1.     J Adv Nurs 2006; 54:553.

2.      Music Ther Perspect 1992; 9:91.

3.      West J Nurs Res 1989; 11:298.

4.     J Adv Nurs 1999; 29:1130.

5.      Cochrane Database Syst Rev 2006; :CD004843.

6.     Hawaii Med J 2007; 66:292.

7.     J Music Ther 2008; 45:349.

Controlling All Three Cardiac Risk Factors Difficult

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It is uncommon that patients with diabetes, hypertension, and hyperlipidemia achieve simultaneous control of all three conditions as per Emily B. Schroeder, MD, PhD, from the University of Colorado Denver in Circulation: Cardiovascular Quality and Outcomes.

Only 15-30% can do that.

The targeted outcomes were hemoglobin A1c <7%, blood pressure <130/80 mmHg, and LDL cholesterol <100 mg/dL.

With less stringent cutoff values (HbA1c <8%, BP <140/90 mmHg, and LDL-C <13mg/dL), the rates of simultaneous controls were 45-70%.

However, simultaneous control was transient in the majority of patients.

Heat And Cold Therapy

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1.     Cold application with ice packs, malleable chemical gel packs, and vapocoolant sprays may reduce muscle spasm, inflammation, and edema [1-3].

2.     It causes initial vasoconstriction, followed by vasodilation.

3.     Various superficial and deep heating methods are applied to control pain and are popular among cancer pain patients [1,4].

4.     Heat is analgesic in part by increasing blood flow and decreasing joint stiffness. It also may induce a state of mental relaxation [1].

5.     Superficial heating with hot packs, heating pads, or baths improves cutaneous blood flow and relaxes muscles and ligaments to a depth of 0.5 cm.

  1. Cancer Pract 1993; 1:137.
  2. Churchill Livingstone, Edinburgh 1994. p.1237.
  3. J Pain Symptom Manage 1994; 9:56.
  4.  Oncol Nurs Forum 1986; 13:56.

In a double-blind study, elderly patients with mild cognitive impairment who consumed high or moderate levels of cocoa flavanols for 2 months had significant improvements on certain cognitive assessment tests compared with those who took in only small amounts, Giovambattista Desideri, PhD, of the University of L’Aquila in Italy, and colleagues reported online in Hypertension.

Meditation forms can be classified as concentrative or non-concentrative:

1. Concentrative techniques limit stimuli input by instructing the patient to focus attention on a single unchanging or repetitive stimulus (sound, breathing, focal point). If the patient’s attention wanders, he or she is directed to bring the attention gently back to the focal object.

2.     Non-concentrative techniques expand the patients’ attention to include the observation, in a non-judgmental way, of one’s mental activities and thoughts.

Benefits associated with meditation include

a.     an improved sense of relaxation

b.     lower levels of perceived stress

c.     more positive thinking

d.     self-confidence

e.     compassion

f.      tolerance of oneself and others [1].

Adverse events may also occur and can be disorientation, confusion, depression, increased awareness of one’s negative qualities and emotions, increased fears and anxiety, boredom, and pain [2].

  1. Am J Psychiatry 1982; 139:267.
  2. Shapiro DH Jr. Adverse effects of meditation: a preliminary investigation of long-term meditators. Int J Psychosom 1992; 39:62.

Loss of a spouse to a heart attack is associated with a significant risk for depression and psychotropic medication use by the surviving partner as per a Danish study by Emil L. Fosbøl, MD, of Duke University published in European Heart Journal.

Compared with the year before the death of a spouse from an acute heart attack during the subsequent year the overall incidence rate ratio for use of an antidepressant was 3.30

In addition, during the month after the fatal heart attack there was a notably high rate of benzodiazepine use by surviving spouses.